Justinian Lane

Contradictory Evidence Regarding Defensive Medicine

Read the passage below and see if you spot a problem:

Diagnostic errors are the leading cause of malpractice suits, accounting for as many as 40% of cases and costing insurers an average of $300,000 per case to settle, studies of resolved claims show. Peter Pronovost, a patient-safety researcher at Johns Hopkins University, estimates that diagnostic errors kill 40,000 to 80,000 hospitalized patients annually, based on autopsy studies over the past four decades.

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One concern is that using claims data to educate doctors will lead to more "defensive medicine," in which doctors order more tests and procedures than needed to protect themselves against malpractice suits. In a study in the June Archives of Internal Medicine, 91% of physicians surveyed reported that doctors practice defensive medicine; the majority of physicians also agreed that legal protections against unwarranted malpractice suits are needed to decrease the unnecessary use of diagnostic tests.

So, on the one hand, 40,000 to 80,000 people die every year because doctors aren’t ordering enough tests. But on the other hand, 91% of physicians say that doctors are ordering too many tests. It makes me wonder just how many people would die every year if doctors weren’t ordering all those “unnecessary diagnostic tests.” Here’s a survey question I’d love to ask doctors: “Have you ever ordered a test only because you were afraid of being sued and ended up getting a result that you did not expect?”